Chapter 42: Musculoskeletal Disorders - NCLEX REVIEW
A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?
0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml. pg.2065
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." b) "Bunions are congenital and can't be prevented." c) "Bunions are caused by a metabolic condition called gout." d) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."
a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion. pg.1140
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Staphylococcus aureus b) Psuedomonas aeruginosa c) Escherichia coli d) Proteus vulgaris
a) Staphylococcus aureus Explanation: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli. pg.1148
A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a) Surgical debridement b) Vitamin supplements c) Wound irrigation d) Wound packing
a) Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis. pg.1149
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? a) Use the large muscles of the leg when lifting items. b) Avoid twisting and flexion activities. c) Sleep on the stomach to alleviate pressure on the back. d) A soft mattress is most supportive by conforming to the body.
a) Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting. pg.1134
During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After age 40, height may show a gradual decrease as a result of spinal compression" b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." c) "The posture begins to stoop after middle age." d) "There may be some slight discrepancy between the measuring tools used."
b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question. pg.1143
A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a) 7 to 10 days b) 3 to 6 weeks c) 6 months d) 3 months
b) 3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months. pg.1148
What food can the nurse suggest to the client at risk for osteoporosis? a) Carrots b) Broccoli c) Bananas d) Chicken
b) Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium. pg.1141
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? a) Hammer Toe b) Corn c) Clawfoot d) Bunion
b) Corn Explanation: A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved. pg.1139
Instructions for the patient with low back pain include that when lifting the patient should a) use a narrow base of support. b) avoid overreaching. c) bend the knees and loosen the abdominal muscles. d) place the load away from the body.
b) avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles. pg.1134
A physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in: a) young menstruating women. b) elderly postmenopausal women. c) young children. d) elderly men.
b) elderly postmenopausal women. Explanation: Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women. pg.1143
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a) Potassium level b) Magnesium level c) Alkaline phosphatase d) Troponin levels
c) Alkaline phosphatase Explanation: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly. pg.1152
Which sign may be helpful in identifying carpal tunnel syndrome? a) Brudzinski's b) Babinski's c) Tinel's d) Kernig's
c) Tinel's Explanation: Tinel's sign may be used to help identify carpal tunnel syndrome. The presence of the Babinski's sign can identify disease of the brain and spinal cord in adults and also exists as a primitive reflex in infants. The Brudzinski's and Kernig's sign are indicative of meningeal irritation. pg.1136
Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? a) Mallet toe b) Hallux valgus (bunion) c) Heberden's nodes d) Hammer toe
d) Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints. This is a finding in degenerative joint disease. pg.1139
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Vitamin supplements c) Wound packing d) Surgical debridement
d) Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement. pg.1148
A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis? a) Bone pain and tenderness b) Bone fractures and kyphosis c) Muscle weakness and spasms d) Softened and compressed vertebrae
a) Bone pain and tenderness Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures. On physical examination, skeletal deformities (spinal kyphosis and bowed legs) give patients an unusual appearance and a waddling gait. pg.1146
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Avascular necrosis c) Fat embolism d) Compartment syndrome
a) Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? a) Instructing the client to ambulate twice daily b) Administering large doses of I.V. antibiotics as ordered c) Withholding all oral intake d) Administering large doses of oral antibiotics as ordered
b) Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited. pg.1148
A client has Paget's disease. An appropriate nursing diagnosis for this client is: a) Fatigue b) Risk for falls c) Delayed wound healing d) Risk for infection
b) Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility. pg.1147
Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? a) Pruritus and uremic frost b) Petechiae over the chest and abnormal ABGs c) Leukocytosis and localized bone pain d) Thrombocytopenia and ecchymosis
c) Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148
Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) Longitudinal arch of the foot is diminished c) High arm and a fixed equinus deformity d) Swelling of the third (lateral) branch of the median plantar nerve
d) Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia. pg.1139
The physician has prescribed plicamycin (Mithracin) to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?
1.5 Explanation: The client weighs 60 kg (132 lbs/2.2 lbs per kg). The client will receive 1500 micrograms (60 kg x 25 micrograms/kg). 1500 micrograms/1000 micrograms per mg = 1.5 mg. pg.1148
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You will receive IV antibiotics for 3 to 6 weeks." b) "Use your continuous passive motion machine (CPM) 2 hours each day." c) "You need to perform weight-bearing exercises twice a week." d) "You need to limit the amount of protein and calcium in your diet."
a) "You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. pg.1148
Of the following, which is not a risk factor for osteoporosis? a) Being male b) Small-framed, thin White or Asian women c) Being postmenopausal d) Family history
a) Being male Explanation: Being male is not considered a risk factor. The following are some of the risk factors for osteoporosis: being a small-framed, thin White or Asian women; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use. pg.1142
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a) Arthroplasty b) Open reduction c) Needle aspiration d) Arthroscopy
d) Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made. pg.1100
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Carpal tunnel syndrome b) Dupuytren's contracture c) Impingement syndrome d) Morton's neuroma
a) Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. pg.1136
When an infection is blood borne the manifestations include which of the following symptoms? a) Chills b) Bradycardia c) Hypothermia d) Hyperactivity
a) Chills Explanation: Manifestations include chills, high fever, rapid pulse, and generalized malaise. pg.1148
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? a) Dorsiflexion exacerbates signs and symptoms of a ganglion. b) Surgical excision is the treatment of choice for a ganglion. c) A ganglion is a precursor to a primary bone tumor. d) A ganglion is the most common benign soft-tissue mass in the foot.
a) Dorsiflexion exacerbates signs and symptoms of a ganglion. Explanation: Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired. pg.1137
Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Dupuytren's contracture b) Callus c) Hammertoe d) Hallux valgus
a) Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. pg.1137
Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Dupuytren's contracture b) Callus c) Hallux valgus d) Hammertoe
a) Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. pg.1137
Dupuytren's contracture causes flexion of which area(s)? a) Fourth and fifth fingers b) Ring finger c) Thumb d) Index and middle fingers
a) Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger. pg.1137
Which of the following was formerly called a bunion? a) Hallux valgus b) Ganglion c) Morton's neuroma d) Plantar fasciitis
a) Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg. 1140
Treatment of metastatic bone cancer includes which of the following? a) Palliation b) Radiation c) Combination chemotherapy and radiation d) Chemotherapy
a) Palliation Explanation: The treatment of metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient's pain and discomfort while promoting quality of life. pg.1152
The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Promote pain relief and quality of life b) Cure the diseased bone and cartilage c) Diagnose the extent of bone damage d) Reconstruct the bone with a prosthesis
a) Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative. pg.1152
Which of the following terms refers to disease of a nerve root? a) Radiculopathy b) Contracture c) Involucrum d) Sequestrum
a) Radiculopathy Explanation: When the patient reports radiating pain down the leg, he or she is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures. pg.1133
Ms. Malcolm has come to your clinic complaining of jaw pain. This is also associated with muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. a) Referral to a dentist who has experience managing clients with TMD b) Analgesics c) Custom-fitted mouth guard during sleep d) Corticosteroids
a) Referral to a dentist who has experience managing clients with TMD b) Analgesics c) Custom-fitted mouth guard during sleep Explanation: Referral to a dentist who has experience managing clients with TMD, analgesics, and custom-fitted mouth guard during sleep are all part of the treatment course. Corticosteroids are not part of the treatment regimen. pg.1241
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? a) Take the supplement with meals or with orange juice. b) Take the supplement on an empty stomach with a full glass of water. c) Remain in an upright position 30 minutes after taking the supplement. d) Take weekly on the same day and at the same time.
a) Take the supplement with meals or with orange juice. Explanation: Calcium supplements, such as Caltrate or Citracal, are over-the-counter medications. They should be taken with meals or with a beverage high in vitamin C. pg.1144
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? a) Temporomandibular disorder b) Trigeminal neuralgia c) Loose teeth d) Dislocated jaw
a) Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw. pg.1236
The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective? a) The patient placed the load close to the body. b) The patient reached over head with arms fully extended. c) The patient used a narrow base of support. d) The patient bent at the hips and tightened the abdominal muscles.
a) The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting. pg.1134
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Walk or perform weight-bearing exercises b) Decrease the intake of vitamin A and D c) Reduce stress d) Increase fiber in the diet
a) Walk or perform weight-bearing exercises Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation. pg.1144
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? a) Walking b) Yoga c) Bicycling d) Swimming
a) Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. pg.1141
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "This condition is associated with various sports." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "Using arm splints will prevent hyperflexion of the wrist."
b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints. pg.1136
Which of the following inhibits bone resorption and promotes bone formation? a) Estrogen b) Calcitonin c) Corticosteroids d) Parathyroid hormone
b) Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis. pg.1143
The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following? a) Hammertoe b) Hallux valgus c) Pes cavus d) Flatfoot
b) Hallux valgus Explanation: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot. pg.1140
Which is a deformity in which the great toe deviates laterally? a) Hammertoe b) Hallux valgus c) Pes cavus d) Plantar fasciitis
b) Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia. pg.1140
During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Mallet toe b) Hammer toe c) Bunion d) Hallux valgus
b) Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint. pg.1139
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? a) Skull narrowing b) Long bone bowing c) Lordosis d) Waddling gait
b) Long bone bowing Explanation: Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Waddling gait is associated with osteomalacia. pg.1146
Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis? a) The pain of plantar fasciitis diminishes with warm water soaks. b) Management of plantar fasciitis includes stretching exercises. c) Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot that occurs when pressure is placed upon it and diminishes when pressure is released. d) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.
b) Management of plantar fasciitis includes stretching exercises. Explanation: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (eg, heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs. pg.1139
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? a) Gastrocnemius b) Quadriceps c) Rectus abdominis d) Latissimus dorsi
b) Quadriceps Explanation: The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3). pg.1135
A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a) Urinary tract infection (UTI) b) Renal calculi c) Benign prostatic hyperplasia d) Dehydration
b) Renal calculi Explanation: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination. pg.1142
A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? a) Proteus b) Staphylococcus aureus c) Salmonella d) Pseudomonas
b) Staphylococcus aureus Explanation: More than 50% of bone infections are caused by Staphylococcus aureus and increasingly of the variety that is methicillin resistant (i.e., methicillin-resistant Staphylococcus aureus [MRSA]) (Miller & Kaplan, 2009). Other pathogens include the gram-positive organisms streptococci and enterococci, followed by gram-negative bacteria, including pseudomonas. pg.1148
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? a) Prone, with a pillow under the shoulders b) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees c) High-Fowler's to allow for maximum hip flexion d) Supine, with the bed flat and a firm mattress in place
b) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: A medium to firm, nonsagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis. pg.1134
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? a) Rapid pulse b) Tenderness over the affected area c) Persistent draining sinus d) High fever
c) Persistent draining sinus Explanation: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection. pg.1148
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. b) The recommended daily allowance of calcium may be found in a wide variety of foods. c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. d) To prevent fractures, the client should avoid strenuous exercise
b) The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary. pg.1143
The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) penicillamine (Cuprimine) b) raloxifene (Evista) c) plicamycin (Mithracin) d) methotrexate (Rheumatrex)
b) raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. pg.1144
A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? a) "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." b) "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home." c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." d) "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving."
c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." Explanation: Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical. pg.1144
Which medication classification is prescribed when allergy is a factor causing the skin disorder? a) Antibiotics b) Local anesthetics c) Antihistamines d) Corticosteroids
c) Antihistamines Explanation: Antihistamines are frequently prescribed when an allergy is a factor in causing the skin disorder. They relieve itching and shorten the duration of allergic reaction. Corticosteroids are used to relieve inflammatory or allergic symptoms. Antibiotics are used to treat infectious disorders. Local anesthetics are used to relieve minor skin pain and itching. pg.1040
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Negative calcium balance b) Dowager's hump c) Bone fracture d) Loss of estrogen
c) Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature. pg.1144
Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD? a) Teriparatide (Forteo) b) Vitamin D c) Calcitonin (Miacalcin) d) Raloxifene (Evista)
c) Calcitonin (Miacalcin) Explanation: Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Forteo has been recently approved by the FDA for the treatment of osteoporosis. pg.1143
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Femur-hip area c) Distal femur around the knee d) Proximal humerus
c) Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites. pg.1151
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? a) Impaired physical mobility b) Risk for infection c) Disturbed body image d) Inadequate nutrition
c) Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image. pg.1153
A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about? a) Cyclobenzaprine (Flexeril) b) Amitriptyline (Elavil) c) Duloxetine (Cymbalta) d) Gabapentin (Neurontin)
c) Duloxetine (Cymbalta) Explanation: Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain. pg.1133
Which of the following presents with an onset of heel pain with the first steps of the morning? a) Morton's neuroma b) Hallux valgus c) Plantar fasciitis d) Ganglion
c) Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg.1139
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a) Denosumab b) Forteo c) Raloxifene d) Fosamax
c) Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures. pg.1144
Which is a risk-lowering strategy for osteoporosis? a) Diet low in calcium and vitamin D b) Increased age c) Smoking cessation d) Low initial bone mass
c) Smoking cessation Explanation: Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D. pg.1141
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? a) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. b) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. c) The nurse is caring for this client on the intensive care unit. d) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.
c) The nurse is caring for this client on the intensive care unit. Explanation: This client is critically ill; his diagnosis and immunosuppression place him at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on his health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions. pg.1151
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Reduce stress c) Walk or perform weight-bearing exercises outdoors d) Increase fiber in the diet
c) Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation. pg.1145
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? a) "I will bend at the waist when I am lifting objects from the floor." b) "Instead of turning around to grasp an object, I will twist at the waist." c) "I will lie prone with my legs slightly elevated." d) "I will avoid prolonged sitting or walking."
d) "I will avoid prolonged sitting or walking." Explanation: The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods. pg.1133
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? a) Elevated levels of alkaline phosphatase b) Increased and decreased areas of bone metabolism c) Demineralization of the bone d) A bone biopsy
d) A bone biopsy Explanation: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample. pg.1146
The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given? a) Raloxifene (Evista) b) Teriparatide (Forteo) c) Denosumab (Prolia) d) Alendronate (Fosamax)
d) Alendronate (Fosamax) Explanation: Alendronate (Fosamax) is a bisphosphonate medication. Raloxifene (Evista) is a selective estrogen receptor modulator. Terparatide (Forteo) is an anabolic agent, and denosumab (Prolia) is a monoclonal antibody agent. pg.1144
Which group is at the greatest risk for osteoporosis? a) Asian women b) Men c) African American women d) Caucasian women
d) Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction. pg.1141
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Cervical b) Thoracic c) Upper lumbar d) Lower lumbar
d) Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes. pg.1133
The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.
d) Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical. pg.2061
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? a) Applying a cock-up splint and immobilization b) Changing the dressing c) Having the patient exercise the fingers to avoid future contractures d) Performing hourly neurovascular assessments for the first 24 hours
d) Performing hourly neurovascular assessments for the first 24 hours Explanation: Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion. pg.1137
A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? a) Maintaining vitamin levels b) Maintaining protein levels c) Promoting range-of-motion (ROM) exercises d) Promoting weight-bearing exercises
d) Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures. pg.1141
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? a) Alendronate (Fosamax) b) Calcium gluconate c) Tamoxifen (Nolvadex) d) Raloxifene (Evista)
d) Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent. pg.1144
A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide? a) Classifying medications b) Increasing calcium and vitamin D in the diet c) Participating in weight-bearing exercises d) Removing all small rugs from the home
d) Removing all small rugs from the home Explanation: A patient with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the patient, but the risk for injury with a fall and potential for a fracture makes safety in the home environment a priority. pg.1143
